Brown Kirsten M, Handa Victoria L, Macura Katarzyna J, DeLeon Valerie B
Department of Anatomy and Regenerative Biology, George Washington University School of Medicine and Health Sciences, 2300 I. St NW, Ross Hall 203A1, Washington, DC 20037, USA.
Int Urogynecol J. 2013 Mar;24(3):431-9. doi: 10.1007/s00192-012-1876-y. Epub 2012 Jul 18.
The objective of this study was to determine whether the three-dimensional shape of the bony pelvis differs between women with and without pelvic floor disorders (PFDs). We predict that the levator ani attachment points for the pelvic floor are further displaced from one another in affected relative to unaffected women.
Pelvic shape was quantified by collecting coordinate data from landmarks located on three-dimensional reconstructions of magnetic resonance images of 19 PFD cases and 16 matched controls. Euclidean distance matrix analysis (EDMA) was used to quantify and compare pelvic shape using these landmark data.
There were no significant group differences in age, parity, body mass, racial attribution, cesarean section, or hysterectomy status. After controlling for size as a confounding factor, EDMA results identified significant differences (p = 0.05) in the bispinous diameter (4 % proportionally larger) and distances defining lateral displacement of ischia from pubis (5-6 % proportionally larger) in cases compared to controls.
Pelvic shape in women with PFDs is characterized by the proportional mediolateral enlargement of the pelvic midplane and ischial eversion near the subpubic arch, consistent with inferolateral migration of the attachment points for the levator ani and correspondingly lateral displacement. These movements may result in increased strain on the pelvic floor's muscular and connective tissues, increasing the risk of failure over a woman's lifetime.
本研究的目的是确定患有和未患有盆底功能障碍（PFD）的女性之间骨盆的三维形状是否存在差异。我们预测，相对于未受影响的女性，受影响女性盆底的肛提肌附着点彼此之间的位移更大。
通过收集19例PFD患者和16例匹配对照的磁共振图像三维重建上地标点的坐标数据来量化骨盆形状。使用欧几里得距离矩阵分析（EDMA）利用这些地标数据量化和比较骨盆形状。
两组在年龄、产次、体重、种族归属、剖宫产或子宫切除状态方面无显著差异。在将大小作为混杂因素进行控制后，EDMA结果显示，与对照组相比，病例组的双棘直径（比例大4%）以及定义坐骨从耻骨侧向位移的距离（比例大5 - 6%）存在显著差异（p = 0.05）。
患有PFD的女性骨盆形状的特征是骨盆中平面的比例性中外侧扩大以及耻骨下弓附近坐骨外翻，这与肛提肌附着点的下外侧移位及相应的侧向位移一致。这些移位可能导致盆底肌肉和结缔组织的应变增加，增加女性一生中出现功能障碍的风险。
